Yamada Takumi, Murakami Yoshimasa, Okada Taro, Yoshida Naoki, Toyama Junji, Yoshida Yukihiko, Tsuboi Naoya, Inden Yasuya, Hirai Makoto, Murohara Toyoaki
Division of Cardiovascular Disease, Cardiac Rhythm Management Laboratory, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
Int Heart J. 2008 Mar;49(2):143-51. doi: 10.1536/ihj.49.143.
The atrial fibrillation (AF) recurrence rate after pulmonary vein isolation (PVI) has been relatively high and in some unsuccessful PVI cases, antiarrhythmic drugs that were ineffective before PVI may become effective (hybrid therapy). The purpose of this study was to investigate the relationship between the brain natriuretic peptide (BNP) level and the effect of the hybrid therapy. In 28 lone AF patients undergoing hybrid therapy, the plasma BNP level was measured before PVI and before and 3 months after administering an antiarrhythmic drug. Fifteen patients were free of AF after the hybrid therapy (effective group), and 13 still had recurrent AF after (noneffective group). At baseline, in all patients the BNP level was elevated, and there were no significant differences in the BNP level between the 2 groups. The BNP level was significantly decreased after PVI in the effective group (56.8 +/- 23.1 versus 37.5 +/- 16.7 pg/mL, P < 0.05) but not in the noneffective group (74.3 +/- 47.8 versus 79.7 +/- 54.4 pg/mL, NS). The elevated BNP level normalized in all effective group patients. The criterion consisting of a net value of < 60.0 pg/mL or a reduction in the BNP level of > 10.0 pg/mL after PVI predicted the effective group patients with a high accuracy. A significant reduction in the BNP level after PVI may be a useful predictor of the responders to antiarrhythmic drug therapy in patients with recurrent AF after PVI. The hybrid therapy may be effective in patients whose PVs serve as a dominant AF substrate.
肺静脉隔离（PVI）术后房颤（AF）复发率相对较高，在一些PVI手术未成功的病例中，PVI术前无效的抗心律失常药物可能会变得有效（联合治疗）。本研究的目的是探讨脑钠肽（BNP）水平与联合治疗效果之间的关系。在28例接受联合治疗的孤立性AF患者中，于PVI术前、给予抗心律失常药物前及给药后3个月测定血浆BNP水平。15例患者联合治疗后无房颤发作（有效组），13例仍有房颤复发（无效组）。基线时，所有患者的BNP水平均升高，两组间BNP水平无显著差异。有效组PVI术后BNP水平显著降低（56.8±23.1对37.5±16.7 pg/mL，P<0.05），而无效组未降低（74.3±47.8对79.7±54.4 pg/mL，无显著性差异）。所有有效组患者升高的BNP水平均恢复正常。PVI术后净数值<60.0 pg/mL或BNP水平降低>10.0 pg/mL这一标准对有效组患者的预测准确率较高。PVI术后BNP水平显著降低可能是PVI术后复发AF患者抗心律失常药物治疗反应的有用预测指标。联合治疗可能对以肺静脉作为主要房颤基质的患者有效。
